Reference no: EM133559127

Case Study: C.O. is a 38-year-old woman who noted a nonpruritic nodular rash on her neck and chest6 weeks ago. The rash became generalized, spreading to her head, abdomen, and armsand was accompanied by polyarticular joint pain and back pain. About 2 weeks ago, sheexperienced three episodes of epistaxis in 1 day. Over the past week, her gums becameswollen and tender and she was severely fatigued. Because of the progression ofsymptoms, she sought medical attention. Lab work was performed, and C.O. was directlyadmitted to the hematology/ oncology unit under the care of a hematologist for diagnosticevaluation. Her chest x-ray examination showed normal lung expansion and heart size,without lymphadenopathy. Skin biopsy showed cutaneous leukemic infiltrates, and bonemarrow biopsy showed moderately hypercellular marrow and collections of monoblasts.Her lumbar puncture specimen was free of blast cells. The final diagnosis was acutemyeloblastic leukemia.

C.O. is to begin remission induction therapy with cytarabine (Ara-C) 100 mg/m2/day as acontinuous infusion for 7 days and idarubicin (Idamycin) 12 mg/m2/day intravenous (IV)push for 3 days. She is scheduled in angiography for placement of a triple-lumensubclavian Hickman catheter before beginning her therapy.

Laboratory Test Results
Complete Blood Count
White Blood Cells (WBCs) 39,000/mm^3
Neutrophils 4%
Blasts 17%
Lymphocytes 15%
Monocytes 64%
Hematocrit (Hct) 28.7%
Hemoglobin (Hgb) 10.4% g/dL
Platelets 49,000/mm^3

Questions:

1.Interpret L.M.'s CBC results. What does the presence of blasts in the differential mean?

2.What was the purpose of the bone marrow biopsy?

3. Considering all the admission data, what potential problem will the nurse be alert for when L.M. returns to the unit after insertion of the catheter?

4.What assessments regarding the central catheter are essential for the nurse to perform?

5.Identify five nursing interventions related to these side effects to include in C.O.'s plan of care.